Field Note: PIVOT’s Community Program
http://pivotworks.org/author/mbonds/
My latest trip to Madagascar began with a two-day 30-mile roundtrip hike to inaugurate health sites in remote communities. We were joined by the local mayor, the head doctor from the local Ministry of Health facility, and members of PIVOT’s community health team. The communities we serve are very remote, requiring people to hike for hours to reach the nearest health center. The residents barely manage a subsistence existence, living off of rice production, sleeping on straw mats on the floors of their thatched roof mud-brick houses. Despite these basic means, each community has managed to pool their limited resources, and combined them with cement from the mayor’s office and a roof provided by PIVOT; on the backs of their own labor, they have constructed simple community health houses that are probably the most distinguished and elegant houses ever seen in these villages. 
They are dignified spaces, with planted flowers, nice fences, and bright white painted walls. They are a perfect representation of the clear commitment these communities have to furthering healthcare for their fellow neighbors. Can you imagine what this means to them? I am proud to say that it is clear that PIVOT’s community health team reciprocates that commitment with medicine, simple equipment, and monthly supervision and training. In these spaces, locally selected community health workers are now providing life-saving medications to children and pregnant mothers. In the decade that I have been doing this work, I don’t think I have ever felt as palpable a sense of pure solidarity across all of the relevant partners as I did when inaugurating these modest community houses.
One of the things that makes our work special is our commitment to the slow, humble, but beautiful process of building relationships around a common mission, showing mutual respect and working hard to make concrete things happen for those in need. This approach, one of true partnership with communities, health workers, civil service, and the national government of Madagascar, is one of the defining features of the culture we have tried to create through PIVOT’s young 3-year history. I am deeply grateful to our health teams for having the character to cultivate these partnerships, and to our leadership for having the wisdom to listen and encourage them.
Our trip was capped by a major milestone that we will never forget. During a small dinner with the Secretary General, the Director General, the Director of Partnerships (and all of the leadership) of the Ministry of Health, the Madagascar Minister of Health presented a certificate of appreciation to PIVOT Co-founders Jim and Robin Herrnstein. The Minister shared that this is the first dinner of this sort that he has ever had with a nongovernmental organization. PIVOT’s new Country Director, Ali Ouenzar, shared his perspective on why this is: PIVOT is legit. We are unique within Madagascar in how we partner at all levels of government in the country in order to serve the communities in ways that truly make them stronger. We are focused in a particular area. We love the communities and our staff.
Though there remains so much more work to do to bring life-saving modern medicine to rural communities in Madagascar, I am proud and grateful to be able to share with you that the foundation that we have been building together could not be stronger.
